Sunday, October 16, 2016

CMS has announced it will hold a town hall call on the new CLFS payment system, data reporting issues. The call will explain how CMS is implementing PAMA for the CLFS, including the June 2016 final rule and subregulatory policy making that has been released since then.

Hold your calendars for Wednesday, November 2 at 230 ET. For the CMS webpage and Registration, see here.

This is a direct cut/paste of the call announcement webpage at CMS, as it stood on October 16, 2016.

Learn how to report data required by the Clinical Diagnostic Test Payment System final rule. Laboratories, including physician office laboratories, are required to report HCPCS laboratory codes, associated private payor rates, and volume data. CMS will use this data to set Medicare payment rates effective January 1, 2018. For more information, see the registration page

The Clinical Laboratory Fee Schedule (CLFS) final rule entitled “Medicare Program: Medicare Clinical Diagnostic Laboratory Tests Payment System” (CMS-1621-F) went on display in the Federal Register on June 17, 2016. The final CLFS rule implements section 216 of the Protecting Access to Medicare Act of 2014.

Under the final rule, laboratories and physician offices are required to report private payor rate and volume data if they have more than $12,500 in Medicare revenues from laboratory services on the CLFS and they receive more than 50 percent of their Medicare revenues from laboratory and physician services during a data collection period.

Laboratories will collect private payor data from January 1, 2016 through June 30, 2016 and report it to CMS by March 31, 2017. CMS will post the new Medicare CLFS rates (based on weighted median private payor rates) in November 2017 that will be effective on January 1, 2018.

Tests that meet the criteria for being considered new advanced tests will be paid at actual list charge during an initial period of three calendar quarters. Once the initial period is over, payment for new advanced tests would be based on the weighted median private payor rate reported by the single laboratory that performs the new ADLT. Advanced tests are tests that are furnished by only one laboratory that include a unique algorithm and, at a minimum, are an analysis of RNA, DNA or proteins or are cleared or approved by the U.S. Food and Drug Administration (FDA).

About the Author

Bruce Quinn MD PhD is an expert on health reform, innovation, and Medicare policy. He helps both large and small companies understand and overcome hurdles to commercialization, as well as craft business strategies for a changing environment. CONTACT Dr. Quinn through www.brucequinn.com. BACKGROUND: Dr. Quinn has worked in academic medicine, Accenture business strategies, and for the Medicare program. EDUCATION: Stanford MD/PhD, MIT Postdoc, Kellogg MBA.